Lecture 15: Psychological treatment in sz – Part ii

Question 1

What were the types of treatments covered in class?

Answer 1

• Individual cognitive and behavioral therapy
• Family interventions
• Neuropsychological and cognitive rehabilitation
• Social skills and related training
• Treatment for comorbid disorders

Question 2

In the chapter on family interventions, we discussed that “Studies in the 60s and 70s revealed that people with SZ who lived in environments high in ______________showed more frequent relapse”

Answer 2

“expressed emotion”

Question 3

What is expressed emotion?

Answer 3

• Critical comments
• Hostility
• Emotional over-involvement

Question 4

“Expressed emotions” can be perceived as something ________ by people with SZ

Answer 4

negative

Question 5

“Expressed emotions” can be seen as part of a _______________

Answer 5

normal reaction to having a family member with a severe mental illness

Question 6

Families may also have incorrect expectations about________________

Answer 6

how much the person with SZ, is going to be able to control their symptoms.

Question 7

Most of family interventions are CBT or _________

Answer 7

psycho-eduction based

Question 8

Family interventions involve assessment and _______________

Answer 8

identification of problems

Question 9

Explain what psychoeducation entails for families of a person with SZ

Answer 9

1) Part of psychoeducation can entail covering the causes of the disorder because people often do not understand the causes, they might blame themselves or the person.
2) They can feel that others don’t understand the causes of the disorder and blame them. It can also be difficult to respect the autonomy of the person with SZ.
3) Whenever possible, the goal is to preserve the privacy and power of making decisions.
4) It also covers the outcome of the disorder, the type of care they may need, the ressources available and guidance on how to deal with stigma.

Question 10

What are the three components covered in a problem-solving focused family intervention?

Answer 10

1) Problem-solving around specific issues, especially medication compliance
2) Identification of symptoms of relapse
3) Strategies in times of increased symptoms

Question 11

In a Problem-solving focused family intervention, what would a session including the person with SZ entail?

Answer 11

Discussion of family concerns, problems

Question 12

In a Problem-solving focused family intervention, what would a session with the family alone entail?

Answer 12

• Allows different forms of education
• Allows family members to express concerns, seek support without fear of the reaction of the person with SZ
• Allows family to express sadness, grief

Question 13

What are the benefits with family treatments?

Answer 13

• Reduce relapse rates
• Reduce hospitalizations and length of hospitalization
• Improve compliance with medications

And most importantly:

• Relatively low-cost (you dont’t necessarily need a large number of session),
• has concrete effects,
• offer support for families (reduce the burden of dealing with a family member with a mental illness, - - can reduce stigma

Question 14

Why would cognitive remediation be part of the treatment for SZ?

Answer 14

• Medications are not very effective for cognitive symptoms (deficits in memory and executive functions).
• Those deficits are important problem for their long-term outcome.
• Cognitive remediation tries to answer the question “Are there techniques that can improve or support better cognitive function?”

Question 15

What is “Neuropsychological therapy”?

Answer 15

• (Another term for Cognitive remediation)
• Interventions or exercises designed to strengthen or support cognitive function
• focus on attention, executive function and memory

Question 16

What are the types of intervention in “Neuropsychological therapy” (i.e Cognitive remediation)?

Answer 16

• Direct task practice
• Attention-shaping
• Real-world tasks

Question 17

Give examples of Direct task practice

Answer 17

• Computerized cognitive training (CPT),
• card or word sorting tasks,
• story recall,
• interpreting social situations,
• problem solving

Question 18

Attention-shaping involves using____________to shape behaviors

Answer 18

Using continuous feedback and reward to shape behaviors

Question 19

Real-world tasks involve _________

Answer 19

Planning activities, making decisions

Question 20

Is Cognitive remediation effective?

Answer 20

Effectiveness is uncertain

Question 21

Why is the effectiveness of cognitive remediation uncertain?

Answer 21

• What is learned does not always translate to real life (not ecologically valid)

Question 22

What were the results of the Computerized cognitive training (reeder, 2017) study?

• Training on a range of basic and “real-world” tasks
• Guided by a therapist (often they are students in psychology program - low cost)
• 93 people with SZ:
  ½ treatment as usual,
  ½ treatment as usual + cognitive training
• 3x per week, 1 hour, 12 weeks, in person
• Baseline, post-training (after 12 weeks), 26 week follow-up (12-14 weeks)
• Testing on standard cognitive tasks:
  Visual spatial memory (reproduce an abstract drawing)
  Executive function (WCST)

Answer 22

-85% of people completed the training
Improvements visual-spatial memory and executive function post treatment
-Gains smaller at follow-up
-Better executive function related to greater engagement in structured activities (school, work, day programs) - and lower positive symptom scores
-Some positive effects, but short term

Question 23

What are the skills that are tested in Computerized cognitive training task “image copy” used in the (reeder, 2017) study?

Hint: You simply have to place shapes into a blank square to copy the image given to you.

Answer 23

• Visual-spatial skills;
• selective attention;
• hand-eye coordination

Question 24

What are skills that are tested in the CPT “where am I”? used in the (reeder, 2017) study.

Hint: You are giving an image and you have to locate that image on a map.

Answer 24

Visual-spatial skills;
visual memory;
abstract spatial skills;
reasoning

Question 25

Discuss the CPT task “Day planning” in the (reeder, 2017) study.

Answer 25

They give you a task of planning a to-do-list. They are given a list and strategies to play the day accordingly (e.x. re-order the list of items)
The skills that are tested are: Planning; time estimation; goal selection [ex: take the task that is the longest and put that one first] (executive function).

Question 26

What does a Social skills training intervention entail?

Answer 26

We know that people with SZ have problems assessing social situations and because they are often experiencing negative hallucinations/delusions they may feel uncomfortable in social situations.

Question 27

Interventions designed to improve:

Answer 27

• Accurate perception and understanding of social situations
• Choice of effective and appropriate responses
• Adequately performing the selected responses

Question 28

Discuss Social skills training

Answer 28

• Most often a group treatment
• Introduction of target social situation
• Identifying appropriate responses
• Identifying problems in making target responses
  i. e., anxiety, shyness, lack of knowledge
• Problem solving (talk about you can solve those problems)
• Role play (mise-en-situations)

Question 29

What are the limitations social training skills effective?

Answer 29

• Effectiveness: limited (It’s effective but limited)
• Best for very specific target behaviors
  (i. e. Going to the bank, making phone calls)
• Limited generalization

Question 30

What are the benefits of Social skills training (i.e. why do people with SZ and clinicians like it)?

Answer 30

• Addresses concrete issues relevant to the person
• Addresses a core area of anxiety
  (social skills are a barrier to employment)

Question 31

What are the co-morbid disorders covered in this lecture?

Answer 31

• Alcohol abuse
• Violence and aggression
• Depression, Anxiety

Question 32

Treatment of co-morbid disorders: Alcohol abuse

Answer 32

• Motivational interviewing to increase engagement in treatment (MI did not change rate of substance use, but decreased the amount of substance used)
• Standard CBT-based treatment

Question 33

Treatment of co-morbid disorders: Violence and aggression

Answer 33

• More severe psychotic symptoms, substance abuse, poor social interactions and poor treatment compliance all related to risk for violence
• Most frequent victims of violence are family members
  [Anger management
  [CBT targeting specific delusions and hallucinations associated with aggression
  [Family interventions

Question 34

Treatment of co-morbid disorders: Depression, Anxiety

Answer 34

• Adjustment to having a severe mental illness
• Loss of friends, partners
• Limited expectations in career and social domains
• Persistent distressing symptoms

Question 35

What are the things that CBT can improve as discussed in the topic on the the importance of Psychological interventions in SZ?

Answer 35

• people’s ability to live with and manage psychotic symptoms
• medication adherence and management of side-effects

Question 36

What are the things that Family and social skills interventions can improve as discussed in the topic on the the importance of Psychological interventions in SZ?

Answer 36

• Family and social skills interventions can improve function and prevent relapse

Question 37

Does cognitive training provide short-term or long-term benefits?

Answer 37

short-term benefits

Question 38

As discussed in the topic on the the importance of Psychological interventions in SZ, which treatment is essential?

Answer 38

Treatment of comorbid disorders